Thromboembolic Complications After Neuroform Stent-Assisted Treatment of Cerebral Aneurysms: The Duke Cerebrovascular Center Experience in 235 Patients With 274 Stents
Thromboembolic Complications After Neuroform Stent-Assisted Treatment of Cerebral Aneurysms: The Duke Cerebrovascular Center Experience in 235 Patients With 274 Stents
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Neuroform 支架辅助治疗脑动脉瘤后的血栓栓塞并发症：杜克脑血管中心 235 名患者使用 274 个支架的经验
DOI：
10.1227/neu.0b013e31821bc49c
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发表时间：
2011
期刊：
影响因子：
4.8
通讯作者：
G. Britz
中科院分区：
文献类型：
--
作者：
M. Lessne;Pratish Shah;M. Alexander;H. Barnhart;C. Powers;K. Golshani;A. Ferrell;D. Enterline;A. Zomorodi;T. Smith;G. Britz
背景：Neuroform支架有助于宽颈脑动脉瘤的血管内治疗。目前尚不清楚哪些因素会导致支架置入后血栓栓塞事件的风险。目的：该系列是报告Neuroform支架置入后血栓栓塞并发症发生率和影响因素的最大单中心研究。方法：共235例患者接受了274枚Neuroform支架治疗。血栓栓塞事件发生率通过支架置入后90天内脑血管意外的影像学或临床证据确定;对于通过病历审查未完成随访的患者，进行电话访谈。进行分析以研究可能与卒中相关的患者因素。结果：大多数动脉瘤未破裂; 30例患者（12.8%）出现急性蛛网膜下腔出血。224例随访患者中有12例（5.4%，95%置信区间：2.4%-8.3%）在支架置入后90天内显示了新发血栓栓塞事件的影像学或临床证据。未破裂动脉瘤的血栓栓塞率为3.1%，蛛网膜下腔出血患者的血栓栓塞率为20%。出血与血栓栓塞事件显著相关（P = 0.002）。高血压患者的血栓栓塞事件发生率有增加的趋势（P = 0.07）。较大的支架口径与血栓栓塞事件发生率降低显著相关（P = 0.032）。结论：我们的结果表明，在未破裂动脉瘤中，与Neuroform支架使用相关的血栓栓塞事件发生率较低。在破裂的动脉瘤中，并发症发生率很高，可能部分与抗血小板治疗的限制使用有关。支架尺寸和高血压可能与卒中风险相关，但需要更多的研究来证实其重要性。
BACKGROUND:The Neuroform Stent has facilitated the endovascular treatment of wide-necked cerebral aneurysms. It is unknown which factors pose risks of thromboembolic events after stent placement. OBJECTIVE:This series is the largest single-center study reporting on the incidence of and factors influencing thromboembolic complications after Neuroform stent placement. METHODS:A total of 235 patients were treated with 274 Neuroform stents. The thromboembolic event rate was determined by imaging or clinical evidence of cerebrovascular accident within 90 days of stent placement; for patients with incomplete follow-up through chart review, telephone interviews were conducted. Analyses were performed to investigate patient factors that may be associated with stroke. RESULTS:Most aneurysms were unruptured; 30 patients (12.8%) presented with acute subarachnoid hemorrhage. Twelve patients of the 224 with follow-up (5.4%, 95% confidence interval: 2.4%-8.3%) demonstrated imaging or clinical evidence of a new thromboembolic event within 90 days of stent placement. There was a 3.1% thromboembolic rate for unruptured aneurysms and a 20% rate in patients with subarachnoid bleed. Hemorrhage was significantly associated with having a thromboembolic event (P = .002). There was a trend toward an increased thromboembolic event rate for patients with hypertension (P = .07). Larger stent caliber was significantly associated with a decreased thromboembolic event rate (P = .032). CONCLUSION:Our results suggest that the thromboembolic event rate associated with Neuroform stent use is low in unruptured aneurysms. In ruptured aneurysms, the complication rate is high, possibly partly related to restricted use of antiplatelet therapy. Stent size and hypertension may be associated with the risk of stroke, but additional studies are needed to confirm their significance.